Sternoclavicular joint dislocation

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Sternoclavicular joint dislocation

• Jason Blackham, MD
• Clinical Assistant Professor
• Division of General Internal Medicine
• University of Iowa Sports Medicine Center

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History

• 17 yo high school quarterback was sacked during a
  game
• Complained of
• Right antero-inferior neck pain
• Dyspnea
• Dysphagia
• Unremarkable PMH

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Physical Exam

• RR 20, HR 84
• Normal mentation and no resp distress
• Neurological exam normal
• Pain with palpation of right clavicle
• Loss of fullness of proximal clavicle
• No skin tenting

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Physical Exam

• Walked off the field
• Postured with head tilted (R), arm at side in IR
  with elbow at 90 degrees flexion
• Off field exam
• Trachea midline, no stridor
• Breath sounds normal, symmetric, resonant
• No cardiac murmer or rub and symmetric pulses
• Transported to ED

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Differential Diagnosis

• Shoulder dislocation
• Proximal clavicular fracture
• Sternoclavicular joint dislocation
• Traumatic pneumothorax

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AF
C
C
BV
T
BV
E
BA
R
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Diagnosis

• Posterior sternoclavicular joint dislocation with
  avulsion fracture

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Closed Reduction
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Treatment

• Reduction under general anesthesia
• 4 weeks immobilized in sling
• 2 weeks of protected ROM, strengthening
• Cornerback for 3 weeks
• Returned to quarterback at 9 weeks

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Epidemiology

• 40 MVC
• 21 Sports
• 39 Other Trauma

• 3 of all shoulder girdle injuries
• gt 90 anterior dislocations

Clin Sports Med 200322387-405 Phys Sports Med
199927(2)105-13
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Mechanisms
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Mechanisms of Posterior

• Fall on shoulder with arm flexed and adducted
• Lateral force to shoulder when shoulder rolled
  forward
• Posterolateral force to shoulder while opposite
  shoulder on ground
• Force to anteromedial clavicle

Clin Sports Med 200322387-405 Military Med
2004169(2)134-6 Rockwood and Greens Fractures
in Adults. 1997
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Complications of Anterior

• SC joint arthritis
• Cosmetic appearance
• Persistent prominence
• Chronic pain
• Recurrent instability

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Complications of Posterior

• Pneumothorax
• Compression or laceration
• Trachea
• Esophagus
• Artery / Vein
• SVC laceration
• Brachial plexus injury
• Thoracic outlet obstruction

J Trauma 199844(2)381-3 Clin Sports Med
200322371-85
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Treatment of Anterior

• Anterior Dislocation
• Controversial
• Majority unstable following reduction
• Sling immobilization for 6 weeks
• If continued symptoms, surgery

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Treatment of Posterior

• Recommendation is for closed reduction
• lt48 hrs to lt7 days of injury
• Sling or figure-of-eight
• Single review article case studies
• good results
• If unstable or complications, then open

Clin Sports Med 200322359-70 Clin Sports Med
200322387-405 Can J Surgery 198629(2)104-6 J
Trauma 19677(3)416-23
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Return to Play

• Sling or figure-eight harness for 4-6 weeks
• Return when pain free motion
• may require additional 4-8 weeks

Military Med 2004169(2)134-6 Phys Sports Med
199927(2)105-13
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Operative Treatment

• Claviculectomy
• Resection of medial clavicle
• Reconstruction of capsule or ligaments
• Not pinning
• Migration of transfixion pins

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Operative Treatment

• Capsule repair with tendon graft
• Burrows procedure
• Sublcavius tendon tenodesis
• Fascia lata graft
• Sternocleidomastoid muscle
• Medial clavicle osteotomy

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Outcome

• Completed FB season without pain or instability
• Pitched for high school baseball team

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Summary

• Posterior SC dislocations are rare
• Potentially severe complications
• Closed reduction is preferred
• RTP after healing and ROM regained
• generally 6-14 weeks